DL-14A (Rev. 11/11)
APPLICATION FOR TEXAS DRIVER LICENSE
FOR DEPARTMENT USE ONLY
OR IDENTIFICATION CARD
RESTRICTIONS/ENDORSEMENTS
NOTICE: All information on this application, except the signature, must be
TYPEWRITTEN or PRINTED in BLACK INK. The signature shall be WRITTEN in
BLACK INK. ONCE THIS APPLICATION FORM AND FEE HAVE BEEN SUBMITTED,
ASSIGNED #
NO REFUNDS WILL BE MADE. Applications held only 90 days.
(Circle Class Desired)
APPLICATION for:
DRIVER LICENSE
COMMERCIAL DRIVER LICENSE (CDL)
CLASS
LEARNER LICENSE
IDENTIFICATION CARD
A
B
C
M
NON-RESIDENT COMMERCIAL DRIVER LICENSE
APPLICANT INFORMATION
CONTACT INFORMATION
LAST NAME:
HOME PHONE:
FIRST NAME:
OTHER PHONE:
MIDDLE NAME:
EMAIL:
SUFFIX:
ADDRESS INFORMATION
MAIDEN NAME:
RESIDENCE ADDRESS: (in line below)
DATE OF BIRTH:
—
—
(MM-DD-YYYY)
CITY:
COUNTY:
SOCIAL SECURITY NUMBER:
STATE:
ZIP CODE:
—
—
COUNTRY:
SEX:
MALE
FEMALE
RACE:
MAILING ADDRESS
EYE COLOR:
HAIR COLOR:
HEIGHT:
ft.
in.
WEIGHT:
lbs.
CITY:
STATE:
ZIP CODE:
COUNTRY:
UNITED STATES CITIZEN: yes
no
PLACE OF BIRTH: CITY:
COUNTY:
STATE:
COUNTRY:
FATHER’S LAST NAME:
MOTHER’S MAIDEN NAME:
REQUIRED INFORMATION FROM ALL APPLICANTS
YES NO
1.
Do you wish to donate $1.00 to the Blindness Education Screening and Treatment Program?
2.
Do you wish to donate $1.00 to the Glenda Dawson Donate Life – Texas Registry?
3.
Would you like to register as an organ donor?
4.
Do you have a health condition that may impede communication with a peace officer? If yes, please list
(must complete form DL-101)
5.
Would you like to complete a voter registration application form today? You must be eligible.
(¿Le gustaria llenar la forma de registro de votante hoy? Tiene que ser elegible.)
6.
Are you a veteran and were you honorably discharged? If yes, what branch of service?
7.
Do you want a veteran designator on your driver license? (proof of honorable discharge required)
8.
Have you ever had a Texas identification card?
Number
When?
9.
Have you ever had a driver license or instruction permit in Texas?
Number
When?
10.
Have you ever had a license or instruction permit in any other state? List state(s)
Number(s)
When?
REQUIRED INFORMATION FROM DRIVER LICENSE APPLICANTS
YES NO
DRIVING HISTORY INFORMATION
11.
Are you enrolled in or have you completed an approved driver education course?
12.
Is your driver license or driver privilege CURRENTLY or EVER been suspended, revoked, canceled, denied or disqualified in ANY state?
Where?
When?
Why?
VEHICLE REGISTRATION AND INSURANCE INFORMATION
13.
Do you own a motor vehicle which is required to be registered (Texas Transportation Code Section 502.002)?
14.
Do you own a motor vehicle which is required to have liability insurance OR other proof of financial responsibility in compliance with the
Motor Vehicle Safety Responsibility Act (Texas Transportation Code Section 601.051)?
APPLICATION CONTINUED ON BACK
FOR DEPARTMENT USE ONLY
DOCUMENT PRESENTED:
DOCUMENT NUMBER:
ISSUING AGENCY:
DOCUMENT PRESENTED:
DOCUMENT NUMBER:
ISSUING AGENCY:
DOCUMENT PRESENTED:
DOCUMENT NUMBER:
ISSUING AGENCY:
DOCUMENT PRESENTED:
DOCUMENT NUMBER:
ISSUING AGENCY:
DOCUMENT PRESENTED:
DOCUMENT NUMBER:
ISSUING AGENCY: